synthetic oxytocin (again sorry!)

[LG]

Sorry here i go again about synthetic oxytocin injection... I'm just trying to understand it and make an informed choice that will be the right one for my baby and my birthing experience.

I am lucky enough to have a personal friend who is a midwife who is looking out for me and sharing her knowledge with me. She is who i am hoping is going to support me through labour. I love her to bits (known her for years) and respect her very very highly. She also has a lot of experience working in maternity wards in hospitals. After raising some of my concerns regarding active management of the third stage of labour, she emailed me back some links to studies that supported active managment for me to compare to see balanced arguments.

Let me get this right though... please please can someone with more knowledge tell me if i'm right? My body will (assuming all goes to plan) naturally produce it's own oxytocin directly after birth that will

• make me fall head over heels with my baby
• stimulate more contractions to expel placenta, and
• reduce blood loss and therefore reduce possibility of PPH

Naturally, oxytocin is produced in the middle of my brian, and when it is released, it is released in little pulses pushing it through my body (?). If it is injected in a synthetic form, it stimulates one big rush of oxytocin throughout me, pushing a large amount of blood through the placenta/cord (?), helping the placenta to come away from the uterus wall sooner, and then in active managment, generally, traction is used to expel the placenta quicker, and PPH is reduced.

So, am i correct then in thinking that IF active managment is facilitated, it's better to go all the way and clamp the cord early to reduce the risks of that large flow of blood causing dramas (jaundice etc) to the baby?

Alternatively, if i stick to my guns about delayed cord clamping, it would be safter to go all the way with expectant managment of the third stage, and allow my baby and body to release the oxytocin at it's natural rate, so there isn't that rush of blood through the cord?

Or is it possible to delay cord clamping, and have the injection administered AFTER the cord is cut? Would that be a compromise?

Right now (after a fair amount of reading), I don't really think that accepting the injection is going to do too much harm to my baby (unless the timing of the cord clamping is a factor?), but I also don't see a really compelling reason to have it either, given that my birth preferences are such that everything i need to stimulate natural production of oxytocin should occur. I am asking that baby be placed directly on my naked chest and for us to be allowed to have skin to skin contact for as long as we need for baby to self-establish breastfeeding.

The research articles i read in support of the injection didn't mention anything about how the control group naturally encourraged the production of oxytocin, and lets face it, the current hospital system doesn't provide the ideal enivronment for stimulation of oxytocin unless we are vocal about our preferences. Am i right?

I am at the point right now where i am starting to feel that the risk of causing stress and tension between my caregivers and myself at this stage could be more detrimental to the birth than accepting a managed third stage of labour. I have to be realistic about that, as my tendancy could be towards sticking to my guns to a point where i have the opposite effects.
A satisfying birth experience is too important to me to get too stubborn about, iykwim?

i need to know that I am understanding what i am reading... so if anyone could clarify or confirm any of that, i would be really really grateful!

[BellyBelly]

Hey Linds, I assume you have read the articles on BB about third stage and clamping... heaps of studies, including recent are there and from the WHO. Someone advocating managed third stage is definitely medical model focused.

If you have had a normal, healthy birth, without a synto drip or instrumental birth, your chance of bleeding is very low. Very low.

See as I always say, it's all about making choices for the birth you want to acheive. You need to give birth in a place of birth that is conducive to your choices, a carer who is conducive and support people who are conducive. Private midwives and birth centres are very used to this choice and are fully understanding of the research and evidence and therefore there is no tension with carers.

Where you are giving birth, they will forget you in a week. But you will never forget your birth experience.

I would suggest negotiation at this point. Relate to them and say that you understand they are concerned at bleeding, but that's not guaranteed to happen. So at this point the answer is no, but you would be open to it if there is concern after the birth about the amount of blood loss and you are not saying no indefinitely. Ideally you can get a minimum of two minutes before the cord is clamped, at very minimum. Once the cord has stopped pulsating and has been clamped, you can have the injection too, it's all your choice. Just be firm, it will only cause tension if you are unsure and leaving the issue hanging - I reckon make your decision and say, this is it, thanks.

[LG]

Thanks, kelly
Yes i have read everything on bellybelly, and i've found it all very interesting and informative. While my head is spinning now, i really am more comfortable and will feel more empowered for having such knowledge whichever way we go. My next appt with my Ob is next week and by then i hope to have my head sorted out one way or the other and i really think i will be quite decisive on what i want.
It really helps to have a forum like this where we can get other views, and other people's experiences. Thank you!

[BellyBelly]

Yep all those things like blood rushes and jaundice are addressed in my articles.

Cord Blood - Why Delaying Cord Clamping Benefits Your Baby
Third Stage of Labour - Benefits of A Natural Approach